Healthcare Provider Details

I. General information

NPI: 1245224708
Provider Name (Legal Business Name): DAVID DEAN GOVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG/SGQX 101 BODIN CIRCLE
TRAVIS AFB CA
94535-1800
US

IV. Provider business mailing address

60 MDG/SGQX 101 BODIN CIRCLE
TRAVIS AFB CA
94535-1800
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7182
  • Fax:
Mailing address:
  • Phone: 707-423-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA87242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: